Osteitis Pubis in Athletes

Infection, Inflammation or Injury?

Summary

Medical records of 59 patients (9 females and 50 males), who presented to sports medicine clinics at the Australian Institute of Sport and the University of British Columbia between 1985 and 1990 and who were diagnosed as suffering osteitis pubis, were reviewed and comparison of data obtained was made with the literature. Women average 35.5 years of age (30 to 59 years) and men 30.3 years (13 to 61 years). Sports most frequently involved were running, soccer, ice hockey and tennis. Clinical presentations of osteitis pubis fell into 4 main groups. ‘Mechanical’ (sport-related) was the largest group (n = 48), followed by ‘obstetric’ (n = 5), ‘inflammatory’ (n = 4) and ‘other’ (n = 2). Period of follow-up averaged 10.3 months (1 to 20 months) in women and 17.5 months (2 to 96 months) in men. Full recovery, when documented, averaged 9.5 months in men and 7.0 months in women. Osteitis pubis recurred in 25% of these men and none of these women at follow-up. The most frequent symptoms were pubic pain and adductor pain. Men also presented with lower abdominal, hip and perineal or scrotal pain; women with hip pain. Most common signs were tenderness of the pubic symphysis and tenderness of adductor longus muscle origin. Men also revealed tenderness of one or both the superior pubic rami and evidence of decreased hip rotation (unilateral or bilateral). Evidence of pelvic malalignment and/or sacroiliac dysfunction was frequently seen in both men and women. There was poor correlation between radiographic and isotope bone scan findings and the site and duration of symptoms and signs. Femoral head ratios were estimated on 30 hips in the series and 2 were judged to be at the upper limit of normal, perhaps indicating a form of epiphysiolysis producing tilt deformity of the head of the femur.

It is clear that osteitis pubis in athletes is not uncommon and that factors such as loss of rotation of hips and previous obstetric history are important in the aetiology and management of this condition. Pelvic infection, which was believed to be the primary factor of osteitis pubis in the literature up until the 1970s, plays a very small role in this condition in athletes.

This is a preview of subscription content, log in to check access.

References

  1. Adams RJ, Chandler FA. Osteitis pubis of traumatic etiology. Journal of Bone and Joint Surgery 35A: 685–696, 1953

    Google Scholar 

  2. Beer E. Periostitis of symphysis and descending rami of pubes following suprapubic operations. International Journal of Medicine and Surgery 37: 224–225, 1928

    Google Scholar 

  3. Bowerman JW. Radiology and injury in sport, pp. 241–245, Appleton-Century-Crofts, New York, 1977

    Google Scholar 

  4. Brodie DM. Running injuries. CIBA Clinical Symposia 32: 5–7, 1980

    Google Scholar 

  5. Chamberlain WE. The symphysis pubis in the roentgen examination of the sacro-iliac joint. American Journal of Roentgenology 24: 621–625, 1930

    Google Scholar 

  6. Cochrane GM. Osteitis pubis in athletes. British Journal of Sports Medicine 5: 233–235, 1971

    Article  Google Scholar 

  7. Coventry MB, Mitchell WC. Osteitis pubis: observations based on a study of 45 patients. Journal of the American Medical Association 178: 898–905, 1961

    PubMed  Article  CAS  Google Scholar 

  8. Elliotson. London Medical Gazette 28: 130, 1827 (cited by Henderson 1950)

    Google Scholar 

  9. Friedenberg ZB. Osteitis pubis with involvement of the hip joint. Journal of Bone and Joint Surgery 32A: 924–947, 1950

    Google Scholar 

  10. Goldstein AE, Rubin SW. Osteitis pubis following suprapubic prostatectomy: results with deep Roentgen therapy. American Journal of Surgery 74: 480–487, 1947

    PubMed  Article  CAS  Google Scholar 

  11. Hanson PG, Angevine M, Juhl JH. Osteitis pubis in sports activities. Physician and Sportsmedicine 6: 111–114, 1978

    Google Scholar 

  12. Harris NH, Murray RO. Lesions of the symphysis in athletes. British Medical Journal 4: 211–214, 1974

    PubMed  Article  CAS  Google Scholar 

  13. Henderson DStCL. Osteitis pubis with five case reports. British Journal of Urology 22: 30–50, 1950

    Article  Google Scholar 

  14. Holder LE, Mathews LS. The nuclear physician and sports medicine. In Freeman LM & Weissman HS (Eds) Nuclear medicine annual 1984, pp. 81–140, Raven Press, New York, 1984

    Google Scholar 

  15. Kirz E. Osteitis pubis after suprapubic operations on the bladder: with a report of 10 cases. British Journal of Surgery 34: 272–276, 1947

    PubMed  Article  CAS  Google Scholar 

  16. Kleinberg S. Osteitis pubis: with a report of a case in a woman. Journal of Urology 61: 83–90, 1942

    Google Scholar 

  17. Kretschmer HL, Sights WP. Periostitis and osteitis pubis following suprapubic prostatectomy. Journal of Urology 23: 573–579, 1930 (cited by Friedenberg 1950).

    Google Scholar 

  18. Legeu and Rochet. Les cellulites perivesicales et pelviennes apres certaines cystostomies ou prostatectomies suspubiennes. Journal d’Urologie Medicale et Chirurgicale 15: 1–11, 1923 (cited by Henderson 1950)

    Google Scholar 

  19. Lloyd-Smith R, Clement DB, Mckenzie DC, Taunton JE. A survey of overuse and traumatic hip and pelvic injuries in athletes. Physician and Sportsmedicine 13: 131–141, 1985

    Google Scholar 

  20. Murray RO, Duncan C. Athletic activity in adolescence as an etiological factor in degenerative hip disease. Journal of Bone and Joint Surgery 53B: 406–419, 1971

    Google Scholar 

  21. Muschat M. Osteitis pubis following prostatectomy. Journal of Urology 54: 447–458, 1945 (cited by Friedenberg 1950)

    PubMed  CAS  Google Scholar 

  22. Peinsoh Jr EL. Osteochondritis of the symphysis pubis. Surgery, Gynecology and Obstetrics 49: 834–838, 1929

    Google Scholar 

  23. Silver CM. Pelvic bone changes following suprapubic prostatectomy. Bulletin of the Hospital for Joint Disease 2: 10–20, 1941

    Google Scholar 

  24. Steinbach HL, Petrakis NL, Gilfillan RS, Smith DR. Pathogenesis of osteitis pubis. Journal of Urology 74: 840–846, 1955

    PubMed  CAS  Google Scholar 

  25. Todd TW. Age changes in the pubic symphysis. VII. The anthropoid strain in human pubic symphysis of the third decade. Journal of Anatomy 57: 274–294, 1923 (cited by Adams and Chandler 1953)

    PubMed  CAS  Google Scholar 

  26. Todd TW. Age changes in the pubic bone. VIII. Roentgenographic differentiation. American Journal of Physical Anthropology 14: 255–271, 1930 (cited by Adams and Chandler 1953)

    Article  Google Scholar 

  27. Walheim G, Olerud S, Ribbe T. Mobility of the pubic symphysis: measurements by an electromechanical method. Acta Orthopaedica Scandinavica 55: 203–208, 1984

    PubMed  Article  CAS  Google Scholar 

  28. Weiss M, Nagelschmidt L, Stauck M. Relaxin and collagen metabolism. Hormone and Metabolic Research 11: 408–414, 1979

    PubMed  Article  CAS  Google Scholar 

  29. Wheeler WK. Periostitis pubis following suprapubic cystostomy. Journal of Urology 45: 467–475, 1941 (cited by Friedenberg 1950)

    Google Scholar 

  30. Williams JGP. Limitation of hip joint movement as a factor in traumatic osteitis pubis. British Journal of Sports Medicine 12: 129–133, 1978

    PubMed  Article  CAS  Google Scholar 

  31. Wiltse LL, Frantz CM. Non-suppurative osteitis pubis in a female. Journal of Bone and Joint Surgery 38A: 500–516, 1956 (cited by Coventry and Mitchell 1961)

    Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Dr Peter A. Fricker.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Fricker, P.A., Taunton, J.E. & Ammann, W. Osteitis Pubis in Athletes. Sports Med 12, 266–279 (1991). https://doi.org/10.2165/00007256-199112040-00005

Download citation

Keywords

  • Symphysis Pubis
  • Bone Scan
  • Pelvic Infection
  • Periostitis
  • Internal Pudendal Artery